Ian Illingworth Flashcards
What does the hepatic vein do
Carries deoxygenated blood to inferior vena cava
What do the left and right hepatic ducts do
Drain bile into the common hepatic duct
What does the hepatic portal vein do
Carries blood from spleen and GI tract to liver
What does the hepatic artery do
Carries oxygenated blood to liver from heart
What is the duct from gall bladder to common hepatic duct
Cystic duct
What are the exocrine hormones secreted by the liver
What do they do
Somatomedin- growth factor
Angiotensinogen- pre cursor to angiotensin which increases blood pressure
Thrombopoetin- platelet production
Hepcidins- blocks iron release
What is the exocrine function of the live
Produces and secretes bile into small intestine via common hepatic duct
Outline the metabolic function of the liver in terms of carbohydrates
Glycogenesis stimulated by insulin
Glycogenolysis stimulated by glucagon
Outline lipolysis in the liver
Lipids absorbed within chylomicron in small intestine are exocytosed and travel through lactiles to thoracic duct to liver where lipids broken down into fatty acids by lipolysis
Which lipids are synthesised in the liver
3
Lipoproteins
Phospholipids
Cholesterol
What proteins are synthesised in the liver
5
Clotting factors Carrier proteins Immune system proteins Albumin Amino acids
Which vitamins does the liver store
5
Which minerals does the liver store
2
A, D, E, K, B12
Iron
Copper
How long are vitamins A and B12 stored in liver
Up to 4 years
How does the liver detoxify ammonia
3
Ammonia produced in intestines
Travels to liver by hepatic portal vein for ornthine cycle
Urea taken time kidneys through circulation
How does the liver detoxify ethanol
Alchohol dehydrogenase converts ethanol to acetaldehyde
How does the liver detoxify drugs
Cytochrome P450 enzymes
What are the phases of digestion and what occurs at each phase and when does each stage happen
Cephalic phase- when food is seen, smelled or thought about- vagus nerve stimulates pancreatic secretions in preperation for digestion
Gastric phase- when food eaten- digestion in stomach stimulates pancreatic secretions
Intestinal phase- when food digested- presence of H+, amino acids and fatty acids stimulates CCK and secretin which stimulate pancreatic secretions
Secretions inhibited- somatostatin and decreasing chyme macronutrients
What substances are secreted by acinar cells of pancrease and how do they ease digestion
3
Zymogen granules: contain digestive enzymes
Sodium ions: water levels in duodenum increase by osmosis
Bicarbonate: increases pH of chyme as enzymes in duodenum need higher pH
Where does bile from common hepatic duct drain into when sphincter of oddi relaxed
Duodenum
Where does bile from common hepatic duct drain into when sphincter of oddi contracted
Gall bladder via cystic duct
What does CCK stimulate in the hepatobillary system
2
Gall bladder contraction
Sphincter of oddi relaxation
What component of bile gives it its colour
Bilirubin
What do bile salts do
What do phospholipids do
Emulsifies fats
Soulubises bile salts
What does red pulp of spleen do
What does white pulp of spleen do
Stores blood in case of haemorrhage , filters blood and removes defective red blood cells
Contains lymphoid tissue that produces antibodies and removes antibody coated bacteria or cells
What structures are at level of C3
Hyoid bone
Bifurcation of common carotid artery
Where is the larynx
C4-C6
Where is thyroid cartilage
C4
Where is the isthmus of thyroid gland
C6
What nerve innervates anterior belly of digastric
Mandibular nerve
What nerve innervates posterior belly of digastric
Facial nerve
What nerve innervates sternomastoid
Accessory nerve
What nerve innervates trapezius
Accessory nerve
What nerve innervates omohyoid
C1-C3
What are the triangles of the anterior neck triangles
4
Submental
Submandibular
Carotid
Muscular
What is the borders of the anterior triangle
Lower border of mandible
Midline of neck
Sternomastoid
What are the borders of the submental triangle
4
Body of hyoid bone
Anterior belly digastric
Midline of neck
Lower border of mandible
What are the contents of submental triangle
5
Mylohyoid nerve Lymph glands Submental lymph nodes Submental branch of facial artery Submental branch of facial vein
What are the borders of the submandibular triangle
3
Lower border of mandible
Anterior belly digastric
Posterior belly digastric
What are the contents of the submandibular triangle
8
Submandibular gland Submandibular lymph nodes External carotid artery Internal carotid artery Facial artery Facial vein Hypoglossal nerve Facial nerve
What are the borders of the carotid triangle
3
Sternomastoid
Omohyoid
Posterior belly digastric
What are the contents of the carotid triangle
7
Common carotid artery Internal carotid artery External carotid artery Internal jugular vein External jugular vein Hypoglossal nerve Vagus nerve
What are the borders of the muscular triangle of the neck
3
Midline of neck
Omohyoid
Sternomastoid
What are the contents of the muscular triangle of neck
7
Common carotid artery Internal carotid artery External carotid artery Internal jugular vein Vagus nerve Hypoglossal nerve Accessory nerve
What are the functions of the lymph node
2
Filtration
Antigen presentation
What is the predominant cell in the paracortex of the lymph node
T cells
What is the predominant cell type in the cortex of the lymph node
2
Macrophages
Plasma cells
What is the primary cell type in secondary lymphoid follicle
B cells
Where does the left deep cervical chain of lymph nodes drain into
Thoracic duct to left internal and subclavian veins
Where does the deep cervivchain of lymph nodes drain into on the right side
Right lymphatic trunk
Drains into right internal or subclavian vein
What are the superficial lymph nodes
10
Submental Submandibular Maxillary Buccinator Supra mandibular Parotid Pre auricular Mastoid Occipital Superior cervical
What are the deep lymph nodes
3
Superior node of deep cervical chain
Middle node of deep cervical chain
Inferior node of deep cervical chain
What are the special lymph nodes of the neck
2
Jugulodigastric
Jugulomohyoid
Where does submental lymph node drain lymph from
3
Lower lip
Floor of mouth
Apex of tongue
Where does the submandibular lymph node drain lymph from
6
Cheeks Lateral nose Gingivae Anterior tongue Submental node Facial nodes
Where does the facial lymph nodes drain lymph from
Mucous membranes of the nose, cheek, eye
Where does the parotid lymph nodes drain lymph from
5
Nose Nasal cavity External auditory meatus Tympanic cavity Lower border of orbit
Where does the pre auricular node drain lymph from
Superficial areas of face and temporal regions
Where does the mastoid lymph node drain lymph from
3
Posterior neck
Upper ear
External auditory meatus
Where does the occipital lymph node drain lymph from
Occipital area of scalp
Where does the superficial cervical lymph node drain lymph from
Superficial surface of neck
Where does the jugulodigastric lymph node drain lymph from
3
Tonsils
Mucosa
Submandibular lymph nodes
Where does jugulo omohyoid lymph node drain from
Tongue
How is the lymph of lower incisors drained
Bilateraly to submental nodes to submandibular nodes to jugulo omohyoid node
How is lymph of upper teeth, lower canines premolars and molars drained
Unilateral drainage to submandibular lymph nodes
To jugulo omohyoid node
What are the trigeminal nuclei, where are they located and what do they govern
Midbrain:
mesenecephalic nucleus- proprioception
Pons:
Chief sensory nucleus- discriminative touch
Motor nucleus- muscles of mastication
Medulla:
Spinal nucleus- pain and temperature
What is the pathway of fibres of mesenecephallic nucleus
Leave nucleus at midbrain
Supply mandibular nerve
Through foramen ovale
What is the pathway of fibres of Chris sensory nucleus
Leave nucleus at pons
Branch and supply ophthalmic nerve through superior orbital fissure, maxillary nerve through foramen rotundum , mandibular nerve through foramen ovale
What is the pathway of fibres of the motor nucleus
Leave nucleus at pons
Supply mandibular nerve
Travel through foramen ovale
What is the pathway of fibres of spinal nerve
Branch and supply ophthalmic nerve through superior orbital fissure, maxillary nerve through foramen rotundum, mandibular nerve through foramen ovale
Which muscles depress the mandible
3
Mylohyoid
Digastric muscle
Lateral pterygoid
Which muscles elevate mandible
3
Medial pterygoid
Massater
Temporalis
Where do afferent and efferent fibres of muscle spindles insert
Afferent- intrafusal fibres
Efferent- intrafusal and extrafusal
What do pacinian corpuscles detect
Pressure using stretch mediated sodium channels
What are the properties of masticatory muscles
5
Short contraction time
Many muscle spindles
Elevators predominantly white fibres performing fast twitching
Do not get fatigued easily
Psychological stress increases activity of elevators
What are the stages of the chewing cycle
3
Jaw opening phase
Jaw closing phase
Power stroke/intercuspal phase
What happens during jaw opening phase of chewing cycle
Lateral pterygoid, digastric and mylohyoid muscles contract to depress mandible
Jaw opens to working side
What happens during jaw closing phase of chewing cycle
Massater, temporalis and medial pterygoid contract
What happens during the power stroke of chewing cycle
Medial pterygoid muscle contracts to crush food between teeth
Buccal phase- lower teeth move inward and upward from first contact to intercuspation
Lingual phase- lower teeth move medialy and downward along palatal cusp of upper teeth
What happens during jaw jerk reflex
3
Tapping chin sends impulses to motor nucleus via mesenocephallic nucleus
Fibres synapse in motor nucleus and send out efferent motor impulses
Elevation of mandible in monosynaptic reflex
What happens during jaw opening reflex
3
Teeth coming into contact with hard object initiates mechanical or electrical stimulation of lips, oral mucosa or teeth
Motor neurones to elevation muscles inhibited
Jaw opens
What happens during the unloading reflex
3
Material between jaws suddenly breaks which is detected by pressure receptors in periodontal ligament
Massateric activity inhibited and digastric activity increases
Jaw prevented from closing forcefully to protect teeth from sudden occlusal load
What are the stages of enamel caries
4
Sub microscopic lesion
White spot lesion
Cavity formation
Bacterial invasion
What are the porosity zones of enamel caries
3
Surface zone
Body of lesion
Dark zone
Translucent zone
What happens at the surface zone of enamel caries and how is this zone protected
Zone remaining in tact during early caries due to mineralisation from deeper ions diffusing out, remineralisation from ions caught in the pellicle, remineralisation from ions in saliva
What occurs at the body of lesion in enamel caries
Greatest demineralisation area
What happens any the dark zone of enamel caries
Enamel doesn’t transmit polarised light so appears dark
When is the translucent zone present and what happens in translucent zone
Occurs in progressive lesion
Submicroscopic pores
What are the pore volumes of Normal enamel Surface zone Body of lesion Dark zone Translucent zone
0.1% 1% 5-25% 2-4% 1%
What are the stages of caries progression into dentine
5
Non bacterial pre cavitation
Migration of pioneer bacteria along tubules
Distortion of tubules by expanding masses of bacteria
Breakdown of intervening matrix forming liquefaction foci
Progressive disintegration of tissue
What are the carious zones in dentine
5
Zone of destruction Zone of bacterial invasion Zone of demineralisation Sclerotic zone Tertiary dentine
What happens at zone of destruction
What colour is it
Area of liquified dentine called liquefaction foci than may contain dentine cracks called transverse clefts
Soft and yellow to harder and brown
Can be removed using excevator
What happens in zone of bacterial invasion
Dentine tubules invaded with bacteria which produces acid and decalcifies dentine
Removed with slow speed bur
What happens in zone of demineralisation of dentine
No bacteria present just the acid they produce which can stain dentine
What happens in sclerotic zone of dentine
Minerals are deposited to block dentine tubules from acid stimuli which may form dead tracts
What happens in tertiary dentine zone
Reactionary dentine produced by existing odontoblasts
Reparitive dentine produced by new odontoblasts
What happens at the dentine pulp complex during caries
Inflammatory response causing neutrophils, lymphocytes and macrophages to move to area and increase pulp vascularisation
What shape is an occlusal fissure cavity
What shape are smooth surface caries
Mushroom
Conical
Define erosion
Define abrasion
Define abfraction
Define attrition
Chemical breakdown of tooth structure
Loss of tooth tissue from frictional wear by extrinsic agents
Loss of tooth structure in cervical region of tooth crown
Frictional tooth wear by tooth to tooth contact
How does vertical adjustment take place
Tooth will lay down secondary cementum to erupt tooth further
What are the triangles within the posterior triangle of the neck
2
Occipital
Supraclavicular
What are the borders of the posterior triangle
3
Trapezius
Sternomastoid
Omohyoid
What are the borders of the occipital triangle
3
Sternomastoid
Trapezius
Inferior belly omohyoid
What is the contents of the occipital triangle
3
Accessory nerve
Cervical plexus branches
Supraclavicular nerve
What are the borders of supraclavicular triangle
2
Inferior belly omohyoid
Sternomastoid
What is the contents of the supraclavicular triangle
4
Subclavian artery
Brachial plexus trunks
Nerve to subclavius
Lymph nodes
